The 7-step checklist for appealing a denied claim

Most denials are appealable. And a meaningful share of appeals succeed — especially when the denial was based on missing information or a coding issue. Here's the short version.

Step 1: Find the deadline Your denial letter must list an appeal deadline. It's commonly 180 days for internal appeals, but plans vary. Write the deadline at the top of every page you keep.

Step 2: Get the exact denial reason in writing "Not medically necessary" is not a reason — it's a category. You're entitled to ask for the specific medical-necessity criteria your plan applied and how your case failed them.

Step 3: Pull the supporting evidence - The original denial letter - The EOB for the denied service - Your provider's notes from the visit - Any prior authorization paperwork - Records of conservative treatment, if relevant (PT, medication, prior imaging)

Step 4: Get a letter of medical necessity This is the single biggest lever. A clear letter from your treating provider explaining why the service was needed — and citing your records — turns a weak appeal into a strong one.

Step 5: Write the appeal letter Stick to facts. Reference the claim number, date of service, and the exact wording of the denial. State what you're requesting (a full reversal) and what you're enclosing.

Step 6: Send it the right way Use certified mail or whichever delivery method your plan accepts. Keep a copy of everything. Note the date you sent it.

Step 7: Track the response window Plans must respond within a defined window (often 30–60 days for non-urgent appeals). If they don't, that's itself grounds for escalation to external review or your state insurance commissioner.

If the internal appeal fails You usually have the right to an **external review** by an independent organization. External reviewers overturn a meaningful share of medical-necessity denials — don't stop after one "no."